Provider Demographics
NPI:1952366791
Name:GOLDSTEIN, GARY I (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:I
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-3627
Mailing Address - Country:US
Mailing Address - Phone:520-750-7255
Mailing Address - Fax:520-545-7261
Practice Address - Street 1:6630 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-722-5868
Practice Address - Fax:520-290-8174
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106472Medicare ID - Type Unspecified
AZE52307Medicare UPIN
AZ106473Medicare ID - Type Unspecified